Why Not Everyone Gets Better in Therapy

Two factors make behavioral and emotional change difficult.

One, the level of entrenched programming in your mind of the self-defeating, irrational or counterproductive thoughts.

Two, the degree to which you’re motivated (or not motivated) to change yourself.

Consider a substance abuse problem, like alcoholism. At the core, alcohol abuse is caused by false beliefs. An example of a false belief is that you’re a victim of life and circumstance, when actually you have lots of choices. Another example of a false belief is the view that you’re worthless, incapable of achieving anything, so you might as well escape through drinking.

These beliefs can be deeply internalized, going back to emotional core evaluations as early as childhood.

Many false beliefs contribute to alcohol abuse or other emotional/behavioral problems. The deeper those beliefs are internalized, the harder it can be to “root them out” and alter them. It’s the same with depression, anxiety, low self-esteem and various other mental maladies.

The second factor is even more important. What determines people’s success in therapy – which I define as self-change – is how much they WANT to be different.

It’s an issue of how high the bar is with respect to what you expect out of yourself and of life.

We’re told that therapy and psychology are strictly scientific endeavors, even biological, having nothing whatsoever to do with ethics. Yet your ethical attitudes and views are part of what make you more or less motivated to become a different kind of person.

A person who decides to think, “I’m better than this” will have a much less difficult time quitting substance abuse or altering his depressed thinking habits than a person who assumes, “What the hell, it doesn’t matter anyway.”

How you think determines what you feel. And your views about right or wrong, good or bad, and what life SHOULD or MIGHT be about all play a role in what you think and feel.

When clients give me the chance, I spend a lot of time with them in therapy on addressing these two points.

As we contemplate massive government spending and efforts to “provide therapy” to sociopaths so they don’t shoot up schools or other places, we would do well to keep this in mind. Getting a therapist to the scene of a person who’s disturbed and troubled is not an automatic guarantee of anything. In most if not all cases, the ones who really want to improve and get better find a way to do so. It’s naive to think that “mental health care for all” will eradicate all that ails society.

Criminals and sociopaths do not see a problem with what they’re doing. They don’t want to change in most (if any) cases. If you think therapy will stop the bloodshed, you are wrong.

Follow Dr. Hurd on Facebook. Search under “Michael Hurd” (Rehoboth Beach DE). Get up-to-the-minute postings, recommended articles and links, and engage in back-and-forth discussion with Dr. Hurd on topics of interest. Also follow Dr. Hurd on Twitter at @MichaelJHurd1